Individual
ZACHARY RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
100 GRAND ST, NEW BRITAIN, CT 06052-2016
(860) 224-5011
Mailing address
100 GRAND ST, NEW BRITAIN, CT 06052-2016
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
04/30/2020
Last updated
07/20/2020
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